Inadequate Cardiovascular Risk Control in Newly Diagnosed Head and Neck Cancer Patients
Patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC) face a significant risk of adverse cardiovascular events due to suboptimal control of cardiovascular risk factors, according to a retrospective study conducted among U.S. veterans. The analysis, published in JAMA Otolaryngology – Head & Neck Surgery, shed light on the prevalence of modifiable risk factors among this population and emphasized the urgent need for targeted interventions to improve risk stratification and mitigation of cardiac risk in HNSCC survivors.
Examining the Cardiovascular Risk Profile
The study, led by Dr. Lova Sun and her colleagues from the Perelman School of Medicine at the University of Pennsylvania, aimed to explore the cardiovascular risk profile of patients with HNSCC. Researchers hypothesized that shared risk factors and cardiotoxic therapies used in the treatment of head and neck cancer could contribute to an increased risk of cardiovascular events. To investigate this, they conducted a population-based cohort study involving 35,897 U.S. veterans diagnosed with HNSCC between 2000 and 2020.
Alarming Prevalence of Modifiable Risk Factors
Among the study cohort, researchers observed a substantial prevalence of modifiable cardiovascular risk factors. Hypertension was found in 67% of patients, while 22.3% had diabetes, and 51.4% had hyperlipidemia. Although most patients were receiving medications for these conditions, 47% had at least one uncontrolled cardiovascular risk factor. Even with medication, 31.8% had uncontrolled blood pressure, 19.9% had uncontrolled lipids, and 15.3% had uncontrolled glucose levels. The findings suggest a critical need for improved management of these risk factors among HNSCC patients.
Racial Disparities in Risk Factor Control
Notably, the study identified an association between Black race and an increased risk of uncontrolled cardiovascular risk factors. Black patients were found to have a 6% higher risk of having an uncontrolled risk factor compared to other racial groups. These findings highlight the importance of addressing racial disparities in healthcare access and quality to improve outcomes and reduce cardiovascular risk in HNSCC patients.
Implications for Patient Care and Survivorship
The 10-year cumulative incidence of stroke and myocardial infarction among the study cohort further emphasized the need for proactive interventions. Stroke had a cumulative incidence of 12.5%, while myocardial infarction had a cumulative incidence of 8.3%. Multivariate-adjusted Cox regression models showed that incident stroke was associated with a 47% increase in the risk of death, and incident myocardial infarction demonstrated a 71% increase in the risk of death. These findings underscore the critical role of multidisciplinary care and collaboration between oncologists and cardiologists in managing cardiovascular risk factors in HNSCC patients.
Addressing Cardiovascular Risk Factors
Dr. Sun emphasized the importance of comprehensive care and proactive efforts from clinicians to improve risk stratification and intervention effectiveness. She noted that risk factors for head and neck cancer and cardiovascular disease often overlap, providing an opportunity for oncologists to play a crucial role in mitigating these risk factors. Encouraging smoking cessation, monitoring and managing blood pressure, and referring high-risk cases to cardiologists and cardio-oncologists can significantly improve survivorship through multidisciplinary care.
In conclusion, the study’s findings shed light on the suboptimal control of cardiovascular risk factors among patients with newly diagnosed HNSCC. The results underscore the urgent need for targeted interventions and improved collaboration between healthcare disciplines to mitigate the risk of cardiovascular events in this vulnerable population. With proactive management and comprehensive care, clinicians can enhance the long-term outcomes and survivorship of HNSCC patients.
